An online global survey and follow-up expert groups on the scope and needs related to training, research, and mentorship among early-career addiction medicine professionals.

Addiction medicine is a rapidly growing field with many young professionals seeking careers in this field. However, early-career professionals (ECPs) face challenges such as a lack of competency-based training due to a shortage of trainers, limited resources, limited mentorship opportunities, and establishment of suitable research areas. The International Society of Addiction Medicine (ISAM) New Professionals Exploration, Training & Education (NExT) committee, a global platform for early-career addiction medicine professionals (ECAMPs), conducted a two-phase online survey using a modified Delphi-based approach among ECAMPs across 56 countries to assess the need for standardized training, research opportunities, and mentorship. A total of 110 respondents participated in Phase I (online key informant survey), and 28 respondents participated in Phase II (online expert group discussions on three themes identified in Phase I). The survey found that there is a lack of standardized training, structured mentorship programs, research funding, and research opportunities in addiction medicine for ECAMPs. There is a need for standardized training programs, improving research opportunities, and effective mentorship programs to promote the next generation of addiction medicine professionals and further development in the entire field. The efforts of ISAM NExT are well-received and give a template of how this gap can be addressed.

Remote supervision in psychiatry training: Unlocking capacity and technology.

OBJECTIVE: This paper explores the literature regarding remote supervision in the context of training in psychiatry with contemporary pedagogic theory and practice and utilising telephonic and videoconference technologies to enhance education outcomes. CONCLUSION: Remote supervision may provide psychiatry trainees with a balance between autonomy and support, promote clinical and professional independence in addition to developing a specific subset of telehealth skills whilst unlocking supervisory capacity to grow the psychiatry workforce, particularly in rural and remote settings.

A systematic review of the effect of ovarian sex hormones on stimulant use in females.

Stimulant use disorder is associated with significant global health burden. Despite evidence for sex differences in the development and maintenance of stimulant use disorder, few studies have focused on mechanisms underpinning distinct trajectories in females versus males, including the effect of the ovarian sex hormones estrogen and progesterone. This review aimed to identify and synthesise the existing preclinical and clinical literature on the effect of ovarian sex hormones on stimulant consumption in females. A systematic search of peer-reviewed literature identified 1593 articles, screened using the following inclusion criteria: (1) adult female humans or animals, (2) using stimulant drugs, (3) ovarian sex hormones were administered exogenously OR were measured in a validated manner and (4) with stimulant consumption as an outcome measure. A total of 50 studies (3 clinical and 47 preclinical) met inclusion criteria. High-estrogen (low progesterone) phases of the menstrual/estrus cycle were associated with increased stimulant use in preclinical studies, while there were no clinical studies examining estrogen and stimulant consumption. Consistent preclinical evidence supported progesterone use reducing stimulant consumption, which was also identified in one clinical study. The review was limited by inconsistent data reporting across studies and different protocols across preclinical laboratory paradigms. Importantly, almost all studies examined cocaine use, with impact on methamphetamine use a significant gap in the existing evidence. Given the safety and tolerability profile of progesterone, further research is urgently needed to address this gap, to explore the potential therapeutic utility of progesterone as a treatment for stimulant use disorder.

Mandatory treatment for methamphetamine use in Australia.

BACKGROUND: In 2016, following a flurry of government inquiries and taskforces including calls for mandatory treatment regimes, the Australian community nominated methamphetamine as the drug most likely to be associated as a problem substance. Mandatory treatment for alcohol and other drug problems in Australia consists of broadly two mechanisms compelling a person into treatment: involuntary treatment or civil commitment regimes; and coercive treatment regimes, usually associated with the criminal justice system. This paper aims to provide a review of the evidence for mandatory treatment regimes for people who use methamphetamines. METHODS: Using a narrative review methodology, a comprehensive literature and citation search was conducted. Five hundred two search results were obtained resulting in 41 papers that had cited works of interest. RESULTS: Small, but robust results were found with coercive treatment programs in the criminal justice system. The evidence of these programs specifically with methamphetamine use disorders is even less promising. Systematic reviews of mandatory drug treatment regimes have consistently demonstrated limited, if any, benefit for civil commitment programs. Despite the growing popular enthusiasm for mandatory drug treatment programs, significant clinical and ethical challenges arise including determining decision making capacity in people with substance use disorders, the impact of self determination and motivation in drug treatment, current treatment effectiveness, cost effectiveness and unintended treatment harms associated with mandatory programs. CONCLUSION: The challenge for legislators, service providers and clinicians when considering mandatory treatment for methamphetamines is to proportionately balance the issue of human rights with effectiveness, safety, range and accessibility of both existing and novel mandatory treatment approaches.

The Youth Stream: evaluating the transition to a new model of care at a regional health service.

OBJECTIVE: To determine what benefits and challenges are associated with a cost-neutral organisational change within a rural Community Mental Health Service from a Traditional Care model to a Youth Stream model. METHOD: Retrospective descriptive analysis of the last 18 months of the Traditional Care model and first 18 months of the Youth Stream model. RESULTS: There was a 17% increase in the number of referrals once the service moved to a Youth Stream model. The increased referral numbers did not lead to a proportionate increase in the number of service contacts, but rather more single assessments were performed. The increased engagement was not reflected across all demographics, with vulnerable youth groups continuing to have below average engagement. Key aspects of data that would allow for further analysis by diagnosis and illness severity were missing from the dataset. CONCLUSIONS: Cost-neutral changes to services can create change, if that change is based on need identified within the service. As much care needs to be taken with data entry and evaluation if the service is aiming to perform a retrospective analysis.

The epidemiology of amphetamine type stimulant-related admissions in Albany, Western Australia: 2008-2013.

OBJECTIVE: To explore the epidemiology of amphetamine type stimulant (ATS)-related admissions over six years in a regional centre, and to observe changes over time and compare demographics to national trends. METHOD: A retrospective audit of patients admitted with an International Classification of Diseases-10 (ICD-10) code relating to ATS use from 2008 to 2013 at Albany Health Campus. Age, gender and reason for admission were compared across each year, including repeat presentations. Concomitant codes during admission were noted. RESULTS: One hundred and fifty two ATS-related hospital episodes were identified during the study period, 55% male and 45% female, with an age range from 16 to 50. Admission numbers increased over time. Patients with multiple admissions made up 35% of episodes. The most common reasons for admission were harmful use (F15.1) and psychotic disorder (F15.5). Sixty-nine percent of admissions had a concomitant ICD-10 code for mental health, 18% another medical code and 28% another factor influencing health status. CONCLUSION: The number of recognised ATS-related presentations is increasing at Albany Health Campus. A broad age range and comparatively high proportion of women were hospitalised. These patients have complex needs and many had multiple ATS-related admissions.